Abstract

Aim: To evaluate the cost-effectiveness of needle and syringe programmes (NSPs) compared to no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom.Design: Cost-effectiveness analysis from NHS/ health-provider perspective, utilising a dynamic transmission model of HCV infection and disease progression, calibrated using city-specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence.Setting: UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%), and Bristol (45%)Population: PWIDInterventions: Current NSP provision is compared to a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years.

Measurements: HCV infections, and cost per quality adjusted life year (QALY) gained through NSPs over 50 years

Findings: Compared to a willingness-to-pay threshold of £20,000 per QALY gained, NSPs were highly cost-effective over a time-horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost-effectiveness ratio was cost-saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78%, 46% and 40% of simulations being cost-saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). Over 90% of simulations were cost-effective at the willingness-to-pay threshold. Results were robust to sensitivity analyses including varying the time-horizon, HCV treatment cost and numbers of HCV treatments per year.

Conclusions: We projected NSPs avert HCV infections and are highly cost-effective in the UK and could be cost-saving to the NHS and other health care providers. NSPs will remain cost-effective in the UK irrespective of changes in HCV treatment cost and scale-up, meaning that NSPs will continue to be an efficient strategy for preventing HCV transmission in the future.